Managing Rheumatoid Arthritis Symptoms and Pregnancy

What Women with Rheumatoid Arthritis Need to Know

Can you still take your medications? What are the chances of passing the condition on to your baby?

And should you breast-feed? Here’s how to plan for a safe baby and healthy mothering. Plus, how much do you know about the types of arthritis? Take our quiz and find out…

Having a baby is a big decision for any woman, but those with symptoms of rheumatoid arthritis have to be especially careful, because the disease complicates pregnancy.

“In a [woman] with rheumatoid arthritis, pregnancy needs to be carefully planned,” says Kelly Weselman, MD, a rheumatologist with WellStar Health System in Atlanta. “Besides finances, childcare and timing, you need to think about your disease and medications.”

Fortunately, because of the array of modern rheumatoid arthritis treatments, now women considering pregnancy have more treatment options. There’s no need to suffer with symptoms of rheumatoid arthritis through pregnancy, she says.

Most important: Start planning early with a rheumatologist and gynecologist experienced in rheumatoid arthritis treatment and care, and continue to consult them through the pregnancy and the first months afterward, says Megan E B Clowse, MD, MPh, assistant professor of medicine in the Division of Rheumatology and Immunology at Duke University Medical Center in Durham, NC.

And be ready for possible problems.

“There will be ups and down,” warns Casey Morris, MD., an obstetrician and gynecologist at West Suburban OB/GYN and Advocate Good Samaritan Hospital in Downers Grove, Ill. “But most women say, ‘I wouldn’t think about not going through the process.’”

Even with proper preparation, women with symptoms of rheumatoid arthritis considering pregnancy naturally will have many worries: How will medications affect the baby? Which ones can I take? Will my baby have RA also? And can I even care for my baby when some days lifting a bag of sugar is painful?

Read on for doctor-recommended answers and advice that’ll help before conception, through pregnancy and post-baby's birth.

Can you still take your medications? What are the chances of passing the condition on to your baby?

There’s a small risk of about 3% that your baby will get rheumatoid arthritis, says Clowse.

“That usually happens later in his life,” she says. “I wouldn’t consider that a reason not to have a baby.”

Nor is rheumatoid arthritis likely to cause problems with the baby during pregnancy, says Weselman.

See your rheumatologist and gynecologist early.Check in with specialists at least six months before trying to conceive so that any drugs you’re taking can get out of your body and you can adjust to new medications you start taking, Clowse advises.

Know which drugs are unsafe.Unsafe drugs during pregnancy include methotrexate (Rheumatrex, Trexall), the most commonly used disease-modifying drugs (DMARD) for rheumatoid arthritis, which slows down disease progression; and leflunomide (Arava), also a DMARD.

Doctors aren’t sure about the impact of TNF inhibitors – tumor necrosis factor alpha blockers such as Remicade and Humira, which suppress the immune system – on unborn babies.

“There’s debate about whether TNF inhibitors are appropriate,” Clowse says. “Animals don’t have problems, but there’s not enough human data to tell us about the outcome.”

Know which drugs are safe.“Plaquenil [hydroxychloroquine] is a very mild DMARD that’s safe during pregnancy,” Weselman says.

So is sulfasalazine [Azulfidine, Sulfazine], an anti-inflammatory.

Pregnant women [with rheumatoid arthritis] also can take prednisone – an anti-inflammatory steroid, says Morris. “Classically, we use a low dose of 10 milligrams a day.”

Can you still take your medications? What are the chances of passing the condition on to your baby?

Prednisone carries a risk of cleft palate if a mother takes it in the first 8-12 weeks of pregnancy. “But even at high doses the risk is not that high,” Morris says.

“Women shouldn’t take a lot of NSAIDs, which in very early pregnancy may increase the risk of miscarriage,” Clowse says. “In the second trimester, they can decrease fluid around the baby.”

Don’t take them at all in the third trimester.

“They can cause changes in the baby’s heart that could be fatal,” she says.

Also, narcotics like Percocet (a mix of oxycodone and acetaminophen) once or twice a week are OK, but any more frequently, watch out.

“If you use it a lot, there’s a risk that the baby could be addicted at birth,” Clowse warns.

Do understand your remission odds.Many women either go into remission or have less disease activity during pregnancy, according to a 2008 Dutch study of pregnant women with rheumatoid arthritis at Erasmus Medical Center in Rotterdam. Researchers found that symptoms of rheumatoid arthritis improved in almost half of the 84 participants.

“We don’t know why [symptoms of rheumatoid arthritis] improve during pregnancy,” Clowse says. “But we suspect the immune system modifies, so that it won’t reject the fetus and then women become more tolerant within their own body too.”

But symptoms of rheumatoid arthritis could get worse once you go off your regular medications.

“Some women [with rheumatoid arthritis] can become incredibly depressed because of pain during pregnancy,” Morris says. “They think they have to suffer because taking anything is terrible for the child.”

But depression too can harm your unborn baby.

“It’s also associated with small growth, miscarriages and high blood pressure, or bonding issues,” Morris says.

Talk to your doctors often and ‘fess up about how much pain you’re in so they can help.

Can you still take your medications? What are the chances of passing the condition on to your baby?

Don’t stress if symptoms of rheumatoid arthritis flare.A flare raises the risk ofa premature delivery by a few weeks. “But that is usually not a big problem,” Weselman says.

The doctor’s concern will be getting symptoms of rheumatoid arthritis back under control with drugs that are baby-safe.

Can you still take your medications? What are the chances of passing the condition on to your baby?

Late PregnancyKnow your risks.The risk of pre-eclampsia – high blood pressure, fluid retention and high levels of protein in the urine – is higher than the normal 5% in healthy women, “particularly if they’re taking prednisone” says Clowse. “That’s why it’s so important to get urinalysis done in close follow-ups with your obstetrician.”

See your doctors more frequently during the third trimester to avoid potential problems.

For example, once patients hit the middle of the second trimester, Morris sees them every two weeks. “Then every week closer to the end of the third trimester.”

Set up your support system.You’ll probably need more than just your husband’s help after the baby is born. So schedule help from friends and family now.

If you can afford it, hire someone to prepare meals and care for the baby so you can sleep.

How Much Do You Know About the Types of Arthritis?About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030. Do you or someone close to you have arthritis? Take this quiz to see how much you know about this disease.

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